Preventing noncommunicable diseases through structural changes in urban environments

The primary determinants of disease are mainly economic and social, and therefore its remedies must also be economic and social. Medicine and politics cannot and should not be kept apart. Rose1 To achieve [a reduction in overweight and obesity] is perhaps the major public health and societal challenge of the century. Potential strategies include [….] redesign of built environments to promote physical activity, changes in food systems, restrictions on aggressive promotion of unhealthy drinks and foods to children and economic strategies such as taxation. Willet

PanDrugs: a novel method to prioritize anticancer drug treatments according to individual genomic data

BACKGROUND: Large-sequencing cancer genome projects have shown that tumors have thousands of molecular alterations and their frequency is highly heterogeneous. In such scenarios, physicians and oncologists routinely face lists of cancer genomic alterations where only a minority of them are relevant biomarkers to drive clinical decision-making. For this reason, the medical community agrees on the urgent need of methodologies to establish the relevance of tumor alterations, assisting in genomic profile interpretation, and, more importantly, to prioritize those that could be clinically actionable for cancer therapy. RESULTS: We present PanDrugs, a new computational methodology to guide the selection of personalized treatments in cancer patients using the variant lists provided by genome-wide sequencing analyses. PanDrugs offers the largest database of drug-target associations available from well-known targeted therapies to preclinical drugs. Scoring data-driven gene cancer relevance and drug feasibility PanDrugs interprets genomic alterations and provides a prioritized evidence-based list of anticancer therapies. Our tool represents the first drug prescription strategy applying a rational based on pathway context, multi-gene markers impact and information provided by functional experiments. Our approach has been systematically applied to TCGA patients and successfully validated in a cancer case study with a xenograft mouse model demonstrating its utility. CONCLUSIONS: PanDrugs is a feasible method to identify potentially druggable molecular alterations and prioritize drugs to facilitate the interpretation of genomic landscape and clinical decision-making in cancer patients. Our approach expands the search of druggable genomic alterations from the concept of cancer driver genes to the druggable pathway context extending anticancer therapeutic options beyond already known cancer genes. The methodology is public and easily integratable with custom pipelines through its programmatic API or its docker image. The PanDrugs webtool is freely accessible at http://www.pandrugs.org .The authors thank Joaquín Dopazo, Patricia León, and José Carbonell for kindly providing the modelled pathways employed in PanDrugs implementation; and Michael Tress for his helpful comments and suggestions in the earlier version of the manuscript.S

Conocimientos tradicionales relativos a la biodiversidad agrícola

La biodiversidad agrícola, a diferencia de la silvestre, requiere la acción continuada de los agricultores para su conservación, ya que las plantas cultivadas dependen de la intervención humana, con actividades como la selección, la siembra, el abonado, la poda u otras prácticas agrícolas para su supervivencia. Desde la revolución agrícola del Neolítico hasta la actualidad, estas prácticas y conocimientos han ido generando y conservando una gran diversidad, amenazada a partir de la segunda mitad del siglo XX por las causas que se han indicado anteriormente.Peer reviewe

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Access to and availability of exercise facilities in Madrid: An equity perspective

Background: Identifying socioeconomic determinants that are associated with access to and availability of exercisefacilities is fundamental to supporting physical activity engagement in urban populations, which in turn, may reducehealth inequities. This study analysed the relationship between area-level socioeconomic status (SES) and access to,and availability of, exercise facilities in Madrid, Spain.Methods: Area-level SES was measured using a composite index based on seven sociodemographic indicators.Exercise facilities were geocoded using Google Maps and classified into four types: public, private, low-cost and sessional.Accessibility was operationalized as the street network distance to the nearest exercise facility from each of the125,427 residential building entrances (i.e. portals) in Madrid. Availability was defined as the count of exercise facilitiesin a 1000 m street network buffer around each portal. We used a multilevel linear regression and a zero inflatedPoisson regression analyses to assess the association between area-level SES and exercise facility accessibility andavailability.Results: Lower SES areas had a lower average distance to the closest facility, especially for public and low-cost facilities.Higher SES areas had higher availability of exercise facilities, especially for private and seasonal facilities.Conclusion: Public and low-cost exercise facilities were more proximate in low SES areas, but the overall number offacilities was lower in these areas compared with higher SES areas. Increasing the number of exercise facilities in lowerSES areas may be an intervention to improve health equity

Access to and availability of exercise facilities in Madrid: An equity perspective

Background: Identifying socioeconomic determinants that are associated with access to and availability of exercisefacilities is fundamental to supporting physical activity engagement in urban populations, which in turn, may reducehealth inequities. This study analysed the relationship between area-level socioeconomic status (SES) and access to,and availability of, exercise facilities in Madrid, Spain.Methods: Area-level SES was measured using a composite index based on seven sociodemographic indicators.Exercise facilities were geocoded using Google Maps and classified into four types: public, private, low-cost and sessional.Accessibility was operationalized as the street network distance to the nearest exercise facility from each of the125,427 residential building entrances (i.e. portals) in Madrid. Availability was defined as the count of exercise facilitiesin a 1000 m street network buffer around each portal. We used a multilevel linear regression and a zero inflatedPoisson regression analyses to assess the association between area-level SES and exercise facility accessibility andavailability.Results: Lower SES areas had a lower average distance to the closest facility, especially for public and low-cost facilities.Higher SES areas had higher availability of exercise facilities, especially for private and seasonal facilities.Conclusion: Public and low-cost exercise facilities were more proximate in low SES areas, but the overall number offacilities was lower in these areas compared with higher SES areas. Increasing the number of exercise facilities in lowerSES areas may be an intervention to improve health equity

Características clínicas y pronóstico a medio plazo de la insuficiencia cardíaca con función sistólica conservada: ¿Es diferente de la insuficiencia cardíaca sistólica?

Objetivos. Analizar la prevalencia, las características clínicas y el pronóstico a medio plazo de los pacientes con insuficiencia cardíaca y función sistólica conservada, y compararlos con los que presentan disfunción ventricular. Pacientes y método. Se incluyó a un total de 153 pacientes, 62 con función sistólica conservada (fracción de eyección ventricular izquierda = 45%) y 91 con disfunción ventricular (fracción de eyección < 45%). El seguimiento medio fue de 25 ± 10 meses. Resultados. Las edades medias fueron similares (66 ± 10 frente a 65 ± 10 años; p = 0,54). La proporción de mujeres fue mayor entre los pacientes con función sistólica conservada (53 frente a 28%; p < 0,01). Las miocardiopatías isquémica e idiopática fueron las causas más prevalentes en pacientes con disfunción sistólica, y las valvulopatías y la cardiopatía hipertensiva, en los que tenían una función sistólica conservada. Los pacientes con función sistólica deprimida recibieron inhibidores de la enzima de conversión de la angiotensina y bloqueadores beta en mayor proporción (86 frente a 52%; p < 0,01 y 33 frente a 11%; p < 0,01). Las tasas de mortalidad (37 frente a 29%), reingresos por insuficiencia cardíaca (45 frente a 45%) y reingresos por otras causas (29 frente a 23%) fueron similares entre ambos grupos, y tampoco difirieron la supervivencia actuarial (51 frente a 62%) ni la probabilidad de no reingresar por insuficiencia cardíaca (50 frente a 52%). La fracción de eyección ventricular izquierda no fue predictora de mortalidad o reingresos por insuficiencia cardíaca. Conclusiones. Una importante proporción de pacientes con insuficiencia cardíaca presentan una función ventricular sistólica conservada. Aunque las características clínicas de estos pacientes son distintas de las de aquellos con disfunción ventricular sistólica, el pronóstico a medio plazo fue simila

Resultados a corto plazo en la técnica de Ross. ¿Influye la etiología de la valvulopatía aórtica?

Introducción. La técnica de Ross se ha establecido como un método de sustitución valvular aórtica apropiado en pacientes pediátricos y adultos jóvenes. Existe controversia sobre los resultados de esta técnica según la valvulopatía aórtica sea congénita o adquirida. El objetivo de este estudio es analizar los resultados de esta técnica en las diferentes etiologías. Pacientes y método. Analizamos a 61 pacientes intervenidos con técnica de Ross desde noviembre de 1997 a noviembre de 2001, con edades comprendidas entre los 6 y los 54 años; de ellos 44 (72%) eran varones. El tiempo medio de seguimiento fue de 15,6 ± 10,6 meses. La lesión valvular fue: estenosis en 17 pacientes, insuficiencia en 22 y doble lesión en 22. Se separó a los pacientes en dos grupos: grupo I, etiología congénita (40 pacientes), y grupo II, etiología adquirida (21 pacientes: en 14, etiología reumática; en 2, degenerativa, en 2, endocarditis, y en 3, otras). Resultados. Los datos preintervención mostraron diferencias significativas en la edad, el grado funcional y el porcentaje de pacientes con cirugía cardíaca previa. En el seguimiento último, los gradientes del autoinjerto y del homoinjerto fueron similares en ambos grupos, sin significación estadística. Los diámetros diastólico y sistólico medios y la fracción de eyección fueron normales en ambos grupos, sin diferencias. Los eventos mayores al seguimiento fueron, en el grupo I: 1 paciente fallecido, 1 caso de endocarditis del autoinjerto y 2 casos de implantación de stent en el homoinjerto; en el grupo II: 2 reintervenciones por disfunción grave del autoinjerto, sin diferencias estadísticamente significativas. Conclusión. La técnica de Ross presenta baja morbimortalidad a corto plazo, independientemente de la etiología